Prairie Estates

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

04/04/2025 reflected that the resident was not seen by the dentist as scheduled. The reason why she was not treated stated Patient was Unavailable: hygiene and was signed by the dentist. Record review of Resident #5's Comprehensive Care Plan dated 07/17/2025 revealed there were no goals or interventions related to dental/oral health care needs. During an interview with Resident #1 on 09/23/2025 at 9:15 AM,

she reported she was having issues with her dentures. She reported the dentures did not fit and they fell off. She stated the dentures didn't look like real teeth and they felt like plastic. Resident #1 stated she was not offered any adjustments, repairs, or replacements. She said it made it difficult to eat and talk when she had them in. She stated she has not worn them since she got them. She stated she had not seen the dentist since she got them and needed to see the dentist again for another pair. She reported she told the Social Worker about the problem and nothing had been done. She reported she also sent an email to the Social Worker about a month ago and the Social Worker never responded. Resident #1 stated a couple of weeks ago she was eating, and she broke a tooth. She reported the tooth was hurting at first, but it no longer hurt. She stated she told her nurse about the broken tooth and was told by the nurse she would relay that information to the Social Worker. She said her tooth broke because she could not wear her dentures.

She reported the broken tooth had made her self-conscious because it had affected the way she talked and chewed. She reported that when she would eat, she had to mostly use her gums and what few teeth she did have. During an interview with LVN A on 09/23/2025 at 10:45 AM, she reported she did not recall any issues regarding Resident #1's dentures or broken tooth. She stated if a resident reported problems with dentures or teeth, she notified the social worker who scheduled dental care either within the facility or with

an outside dentist, and she also informed the physician as appropriate. She reported she was unsure why Resident #1 did not wear her dentures and stated that the resident refused to wear them. During an

interview with CNA B on 09/23/2025 at 11:00 AM, she reported she was not aware that Resident #1 wore dentures. She reported she had never seen her wearing her dentures. During an interview with the Regional Director of Clinical Services on 09/23/2025 at 2:30 PM, he stated he was unaware that Resident #1's care plan did not address dental needs. He stated it was something that would need to be in her care plan. He stated the risk to the resident was not receiving appropriate interventions. The facility's Care Plan, Comprehensive Person-Centered dated March 2022 reflected the comprehensive, person-centered care Plan includes the measurable objectives and time frame .includes the residents stated goals and desire outcome . the interdisciplinary team reviews and updates the care plan: when there has been significant change in the residents condition, when the desired outcome is not met; when the resident has been readmitted to the facility from a hospital stay; and at least quarterly.

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Prairie Estates

1350 Main St Frisco, TX 75034

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0790 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

the missing paperwork for Resident #1's re-enrollment for dental care today when she called [dental company] to confirm the residents' status of seeing the dentist in October. She reported she was not sure why the physician's form was not sent in. She further stated that the forms are not sent together by the [dental company]. She reported the forms were due at different times during the year so the forms were sent to her as they are due, which could have caused the physician form to not have been sent to her yet.

The Social Worker stated she kept track of the forms by completing them as they were sent to her. During

an interview with the Regional Director of Clinical Services on 09/23/2025 at 2:30 PM, he stated he was unsure why the resident was not seen per schedule by the dentist. He reported the resident should have been seen or rescheduled. He reported the resident was at risk of the broken tooth and ill-fitting dentures could affect her eating. Record review of the facility policy titled Dental Services, dated December 2013 reflected the following policies regarding dental services for residents: Oral health services are available to meet the resident's needs.Routine and emergency dental services are provided to our residents through:A contract agreement with a local dentist;Referral to the resident's personal dentist;Referral to community dentists; orReferral to other health care organizations that provide Dental Services.Our facility has a contract with a dentist that comes to the facility and provides dental services on a monthly basis.Residents are permitted to select dentists of their choice when dental care or services are needed.Selected dentists must be available to provide follow-up care.Failure of a dentist to provide follow-up services will result in the facility's right to use its Consultant Dentist to provide the resident's dental needs.A complete record of the resident's dental care and services are maintained in accordance with current regulations.Social Services personnel will be responsible for assisting the resident/family in making dental appointments and transportation arrangements as necessary.

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